Erectile dysfunction, diabetes and cardiovascular risk

Abstract

Erectile dysfunction (ED) occurs in up to 75% of men with type 2 diabetes (T2DM) and has a complex pathogenesis owing to a combination of microvascular, macrovascular, endocrine and neuropathic disease. ED is established as an independent marker for the development of coronary artery disease (CAD) occurring on average 3-5 years before the onset of CAD. Thus, timely detection of ED offers an opportunity for early intervention, thereby reducing morbidity associated with CAD. The average UK male, however, suffers for 3 years before discussing symptoms of ED with a healthcare professional. The National Institute for Health and Care Excellence (NICE) recommends an annual review of ED symptoms in susceptible patients with T2DM with an appropriate discussion of management options. Screening questions regarding ED were introduced in the 2013 Quality Outcome Framework but were removed by NHS England in 2014 on grounds of ‘simplification’. Response to treatment strategies for ED is poor in diabetes, and poor glycaemic control, long duration of disease and severity of complications is predictive of a poor treatment response. The concomitant presence of hypogonadism in over 40% of men with T2DM also makes ED difficult to treat in this group. Further, ED and severe hypogonadism have been shown to independently predict mortality in T2DM. Treatment for ED is more likely to be effective if given early, although complex regimens may be required.